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This is VAERS ID 311823

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311823
VAERS Form:
Age:0.5
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 1 LL / ID
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015D / 1 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Haematemesis, Intussusception, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked w"ith blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 12/8/2009

VAERS ID: 311823 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 1 LL / ID
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015D / 1 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Haematemesis, Intussusception, Vomiting, X-ray abnormal, Enema administration, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked w"ith with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 3/2/2010

VAERS ID: 311823 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 1 LL / ID
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B54015D / 1 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Haematemesis, Intussusception, Vomiting, X-ray abnormal, Enema administration, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 4/7/2010

VAERS ID: 311823 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 1 LL / ID
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015D / 1 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Haematemesis, Intussusception, Vomiting, X-ray abnormal, Enema administration, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 8/31/2010

VAERS ID: 311823 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 1 LL / ID
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54015D / 1 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Haematemesis, Intussusception, Vomiting, X-ray abnormal, Enema administration, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 5/13/2013

VAERS ID: 311823 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 1 LL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Haematemesis, Intussusception, Vomiting, X-ray abnormal, Enema administration, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 2/14/2017

VAERS ID: 311823 Before After
VAERS Form:
Age:0.5 0.54
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 1 LL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Haematemesis, Intussusception, Vomiting, X-ray abnormal, Enema administration, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 4/14/2017

VAERS ID: 311823 Before After
VAERS Form:
Age:0.54
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 1 LL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Haematemesis, Intussusception, Vomiting, X-ray abnormal, Enema administration, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 9/14/2017

VAERS ID: 311823 Before After
VAERS Form:(blank) 1
Age:0.54
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 1 2 LL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 2 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, X-ray abnormal, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 2/14/2018

VAERS ID: 311823 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 2 LL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, X-ray abnormal, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 6/14/2018

VAERS ID: 311823 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 2 LL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, X-ray abnormal, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 8/14/2018

VAERS ID: 311823 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 2 LL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, X-ray abnormal, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 9/14/2018

VAERS ID: 311823 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 2 LL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, X-ray abnormal, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.


Changed on 10/14/2018

VAERS ID: 311823 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Kentucky
Vaccinated:2008-02-14
Onset:2008-02-25
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZIBI37AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF328AA / 2 LL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, X-ray abnormal, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant .
CDC 'Split Type':

Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700.

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